If you have been researching Medicare, you might have come across something called Medicare Part B excess charges. The world of Medicare insurance and expenses is a seemingly never-ending cycle of paying for this or paying for that. The Medicare Part B excess charge is another financial component for some Medicare Plans.
The good news is that Medicare Part B excess charges are rather rare and there are ways to skirt around the issue.
What Are Medicare Part B Excess Charges?
In short, Medicare Part B excess charges occur when your provider does not accept Medicare assignment and then charge you up to 15% more than what Medicare approves for the service.
It is essential to understand that doctors and other healthcare providers can choose to participate with Medicare or decline. When a provider participates in Medicare, they must agree to only charge you the Medicare-approved amount for their services.
This is called “accepting Medicare assignment.”
What is Medicare Assignment?
When a healthcare provider accepts Medicare assignment rates, it means that they will not charge you more than the Medicare-allowable rate as determined by Medicare. This applies to participating providers.
Providers who do not participate in Medicare have the option to bill you up to 15% above the Medicare allowable amount at their discretion. This additional charge is known as a Part B excess charge. You will be responsible for paying this amount out-of-pocket unless you have a Medigap plan that covers Part B excess charges.
Choosing a participating provider offers additional benefits besides avoiding Part B excess charges if you have Medicare:
- Participating providers will only collect your Part B deductible and/or coinsurance amount at the time of service. They typically wait until Medicare has paid its share before billing you. Non-participating providers may require full payment upfront.
- Participating providers are required to submit your claim to Medicare on your behalf at no cost to you. Non-participating providers, however, may not bill Medicare directly, so you would need to file a claim yourself to receive reimbursement.
How Will I Know If My Provider Will Bill for the Part B Excess Charge?
The good news about the Medicare Part B excess charge is that you can simply ask your provider if they charge it. You do not have to be surprised by the extra cost whatsoever. Ask your provider upfront if they accept Medicare, your plan, and if they charge for the Part B excess charge. It is that simple.
Keep in mind that you may need to ask more than just your provider about these Medicare Part B excess charges. Be sure to ask when you get lab work done, visit a home healthcare facility or see a specialist.
How Else Can I Avoid These Charges?
Besides asking if your provider charges Medicare Part B excess charges, you have another way to avoid them. If you choose Medigap Plan F or G, you will not pay these charges. These two Medigap Plans cover the excess charges.
Final Thoughts
Medicare Part B excess charges can seem a little tricky to understand. You can get coverage to avoid paying it altogether. You can also opt for a Medigap Plan that includes this as coverage. Either way, it is important to understand your benefits and how Medicare works for you.
Medicare as a whole can be a difficult world to navigate. However, you never have to do it alone. When you work with MedicareInc.com, you will always have access to information and non-stop support. Our services are always free to you. Get a quote today.
